A client arrives at the health care clinic and tells the nurse that she was just bitten by a tick and would like to be tested for Lyme disease. The client tells the nurse that she removed the tick and flushed it down the toilet. Which actions are most appropriate?

Correct Answer: B

Rationale: The correct answer is B: Inform the client to plan to have a blood test 4 to 6 weeks after a bite to detect the presence of the disease. Rationale: 1. Lyme disease testing is most accurate 4-6 weeks post-bite due to the time required for antibodies to develop. 2. Testing too early may result in false negatives. 3. Waiting allows for accurate detection and timely treatment if needed. Summary of Other Choices: A: Incorrect. Arthralgia is just one symptom; testing is needed for accurate diagnosis. C: Incorrect. While prevention is important, this does not address the immediate need for testing. D: Incorrect. Antibiotics should not be started without proper diagnosis to avoid unnecessary medication.

Correct Answer: C

Rationale: The correct answer is C: Desmopressin (DDAVP). This patient likely has von Willebrand disease, a common bleeding disorder. Desmopressin releases von Willebrand factor and factor VIII from endothelial cells, aiding in hemostasis. Factor VIII concentrate (A) is used for hemophilia A, not von Willebrand disease. Fresh frozen plasma (B) contains various clotting factors but is not specific for von Willebrand disease. Whole blood transfusion (D) is not necessary in this case and does not address the underlying issue.

Correct Answer: A

Rationale: The correct answer is A: CT scan of abdomen. In a 69-year-old man with weight loss, back pain, and hyperglycemia, a CT scan of the abdomen is the most likely diagnostic study to identify potential underlying causes such as pancreatic cancer or other abdominal malignancies. This imaging modality can provide detailed information on the pancreas, surrounding structures, and possible metastases. Summary: B: Glucose tolerance test is not the most appropriate initial study for a patient presenting with these symptoms. C: Colonoscopy is indicated for evaluating lower gastrointestinal symptoms, not typically for weight loss, back pain, and hyperglycemia. D: Whole-body PET scan may be used for cancer staging, but a CT scan of the abdomen is more specific for identifying abdominal malignancies.

Correct Answer: C

Rationale: The correct next diagnostic study for a 26-year-old man with testicular mass and periaortic lymphadenopathy is to measure α-fetoprotein, β-hCG, and LDH levels (Choice C). This is because these tumor markers (α-fetoprotein, β-hCG, LDH) are essential in the evaluation of testicular cancer. Elevated levels of these markers can indicate the presence of germ cell tumors. Needle biopsy of a retroperitoneal mass (Choice A) would not be the initial step as it does not directly evaluate the testicular mass. Needle aspiration of the testicular mass (Choice B) may yield limited information compared to tumor marker levels. PET scan (Choice D) is typically not the first-line investigation for testicular cancer evaluation.

Correct Answer: B

Rationale: The correct answer is B: Thalassemia. Thalassemia is a genetic disorder characterized by abnormal hemoglobin production, leading to microcytic anemia with low MCV. In this case, the patient's low MCV of 62 indicates microcytic anemia, which is consistent with thalassemia. Normal iron studies rule out iron deficiency anemia (Choice C). Anemia of chronic disease (Choice D) typically presents with normocytic or mildly microcytic anemia, unlike the severe microcytic anemia seen in thalassemia. Sideroblastic anemia (Choice A) is characterized by ringed sideroblasts in the bone marrow and elevated ferritin, which are not present in this patient.